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General NPI Number Information
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NPI Number | 1871091173
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Entity Type | Individual
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Provider Name | SANDEEP KAUR MANN RDHAP
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Gender | Female
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 3384 AMY DR
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City | CORONA
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State | CA
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Zip | 92882-8794
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Country | US
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Telephone | 120-953-4795
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Fax | 209-534-7959
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Provider Business Mailing Address
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Address Line | 3384 AMY DR
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City | CORONA
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State | CA
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Zip | 92882-8794
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Country | US
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Telephone | 209-534-7959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 125J00000X
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Taxonomy Name | Dental Therapist
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License Number | HAP674
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License Number State | CA
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